<!DOCTYPE html>
<html>
<head>
<meta charset="utf-8">
<title>用户管理-编辑</title>
<meta name="renderer" content="webkit">
<meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1">
<meta name="viewport"
	content="width=device-width, initial-scale=1, maximum-scale=1">
<meta name="apple-mobile-web-app-status-bar-style" content="black">
<meta name="apple-mobile-web-app-capable" content="yes">
<meta name="format-detection" content="telephone=no">
<link rel="stylesheet" href="./css/x-admin.css" media="all">
</head>

<body>
	<div class="x-body">
	<form action="Dangan-add.do" method="post">
		<table class="layui-table">
			<tbody>
				<tr>
					<td><span class="x-red">*</span>姓名</td>
					<td><input type="text" id="patient_name" name="patient_name"
						class="layui-input"></td>
					<td>性别</td>
					<td><select lay-verify="required" name="patient_sex" id="patient_sex"
						class="layui-input">
							<option value="男">男</option>
							<option value="女">女</option>
					</select></td>
					<td>籍贯</td>
					<td><input type="text" id="patient_home" name="patient_home"
						class="layui-input"></td>
				</tr>
				<tr>
					<td>出生日期</td>
					<td><input type="Date" id="patient_born" name="patient_born"
						class="layui-input"></td>
					<td>年龄</td>
					<td><input type="text" id="patient_age" name="patient_age"
						class="layui-input"></td>
					<td>宗教信仰</td>
					<td><input type="text" id="patient_believe" name="patient_believe"
						class="layui-input"></td>
				</tr>
				<tr>
					<td>出生地</td>
					<td><input type="text" id="patient_bornAddress" name="patient_bornAddress"
						class="layui-input"></td>
					<td>文化程度</td>
					<td colspan="3"><select lay-verify="required" name="patient_education" id="patient_education"
						class="layui-input">
							<option value="小学">小学</option>
							<option value="初中">初中</option>
							<option value="大学">大学</option>
					</select></td>
				</tr>
			
				<tr>
					<td>通讯地址</td>
					<td colspan="3"><input type="text" id="patient_address" name="patient_address"
						class="layui-input"></td>
					<td>联系电话</td>
					<td><input type="text" id="patient_phone" name="patient_phone"
						class="layui-input"></td>
				</tr>
				<tr>
					<td colspan="6" align="right"><button class="layui-btn">
							保存</button>
						<button class="layui-btn">取消</button></td>
				</tr>
			</tbody>
			
		</table>
		</form>
	</div>
	<script src="./lib/layui/layui.js" charset="utf-8">
        </script>
	<script src="./js/x-layui.js" charset="utf-8">
        </script>
	<script>
            layui.use(['form','layer'], function(){
                $ = layui.jquery;
              var form = layui.form()
              ,layer = layui.layer;
            });
        </script>
</body>
</html>